MRSA declines in VA hospitals after federal initiative

Health care-associated MRSA rates fell substantially in Veterans Affairs facilities over the course of 8 years following the introduction of the Veterans Affairs MRSA Prevention Initiative, according to findings recently published in the American Journal of Infection Control.

A press release accompanying the study reported that MRSA infection rates were “unacceptably high” leading up to 2007, prompting the U.S. Department of Veterans Affairs to implement the initiative at all VA facilities in October of that year. It included having a dedicated MRSA prevention coordinator at each facility to oversee intervention bundles, such as universal active screening for MRSA on admission, during unit-to-unit transfers and upon discharge; contact precautions for patients colonized or infected with MRSA; hand hygiene adherence; and “institutional culture change” to make infection prevention the responsibility of everyone at the facility.

“Understanding how and why rates of MRSA have diminished in recent years is essential for the continued progress of effective prevention programs,” Martin E. Evans, MD, of the MRSA/MRDO prevention office, National Infectious Diseases Service and Patient Care Services at the Veterans Health Administration, Washington, DC., said in the press release. “As we seek to protect patients from MRSA and other resistant organisms, our study supports the need for strong infection prevention programs at every healthcare facility.”

Evans and colleagues reviewed monthly data from 133 long-term care facilities, 22 spinal cord injury units and 127 different acute care facilities around the United States, resulting in 23,153,240 ICU and non-ICU patient-days, as well as 1,794,234 patient-days in spinal cord injury units from October 2007 to September 2015. Researchers also evaluated 22,262,605 long-term care facility patient days from July 2009 to September 2015.

MRSA prevalence at admission increased slightly from 13.2% to 13.5% in acute care facilities, Evans and colleagues wrote, and from 23.1% to 25% in long-term care facilities. Admission prevalence fell in spinal cord injury units during the study period, from 35.1% to 32%.

In September 2015, ICUs had two health care-associated MRSA infections, non-ICUs had 20, including three in spinal cord injury units, and long-term care facilities had 31. Monthly infection rates plunged in all three types of facilities, researchers wrote. Infection rates fell by 49.4% in long-term care facilities, 80.9% in spinal cord injury units, 80.1% in non-ICUs and 87% in ICUs.

“We speculate that active surveillance was the primary driver of the downward trends seen in the VA, because MRSA health care-associated infection rates had not changed prior to October 2007 when the initiative was fully implemented, even though formal recommendations for hand hygiene and device-related infection control bundles had been in place for several years,” Evans and colleagues wrote. – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.

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Perspective

PERSPECTIVE

Linda McKinley

The article written by Dr. Evans and colleagues describes a hugely successful and sustained effort in the reduction of methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) within the Department of Veterans Affairs (VA) following a national infection control initiative. The results found MRSA HAI reductions ranging from 49% to 87% in both acute and long-term health care settings.

The VA MRSA prevention initiative involved implementation of several evidence-based infection control practices bundled together, referred to as the MRSA bundle. The components of the MRSA bundle include hand hygiene as the cornerstone for infection prevention, contact barrier precautions where health care workers wear gowns and gloves when caring for patients infected or colonized with MRSA, screening cultures of all hospitalized patients to detect asymptomatic carriage of MRSA and health care worker engagement in the culture that infection control is everyone’s responsibility. The VA also invested in additional infection control personnel at each VA facility to facilitate implementation of the MRSA prevention initiative. Costs of the initiative are not addressed in this article.

The authors note that although the MRSA bundle was instrumental in its effectiveness, it is also considered a limitation in drawing definitive conclusions. The limitation occurs when interventions are bundled together; in this situation, it becomes difficult to measure the individual effect of each component on the desired outcome. The use of bundled interventions is a common practice in infection control emerging from both the desire to prevent infections and the belief that the majority of evidence is based on observational quality improvement evaluations.

Today’s health care environment requires transparency of outcomes, including HAIs. This leaves facilities to discern between available evidence and limited resources in what to implement for their patients. HAI bundles have been reported to be effective, but the next steps are to further evaluate the role of individual components through well-designed studies.